Skip to main content
Log in

Chronic back pain and rheumatoid arthritis: Predicting pain and disability from cognitive variables

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Cognitive-behavioral models of chronic pain emphasize the importance of situation specific as well as more general cognitive variables as mediators of emotional and behavioral reactions to nociceptive sensations and physical impairment. The relationship of situation-specific pain-related self-statements, convictions of personal control, pain severity, and disability levels was assessed in samples of chronic back pain and rheumatoid arthritis patients. Both the more general and the situation-specific sets of cognitive variables were more highly related to pain and disability than disease-related variables. This association was found in the back pain patients who displayed only marginal levels of organic findings as well as the rheumatoid arthritis sample who had a documented basis for their pain. The combination of both situation-specific and general cognitive variables explained between 32 and 60% of the variance in pain and disability, respectively. The addition of disease-related variables improved the predictions only marginally. These results lend support to the importance of cognitive factors in chronic pain syndromes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Averill, J. R. (1973). Personal control over aversive stimuli and its relationship to stress.Psychol. Bull. 80: 286–303.

    Google Scholar 

  • Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change.Psychol. Rev. 84: 191–215.

    Google Scholar 

  • Beck, A. T. (1976).Cognitive Therapy and Emotional Disorders, International Universities Press, New York.

    Google Scholar 

  • Beck, A. T., and Weismann, A. (1974). The measurement of pessimism: The Hopelessness Scale.J. Consult. Clin. Psychol. 42: 861–865.

    Google Scholar 

  • Biedermann, H. J., McGhie, A., Monga, T. N., and Shanks, G. L. (1987). Perceived and actual control in EMG treatment of back pain.Behav. Res. Ther. 25: 137–147.

    Google Scholar 

  • Binik, Y. M. (1983). Coping with chronic life threatening illness: Psychosocial perspective on end-stage renal disease.Can. J. Behav. Sci. 15: 373–391.

    Google Scholar 

  • Blumer, D., and Heilbronn, M. (1982). Chronic pain as a variant of depressive disease. The pain-prone disorder.J. Nerv. Ment. Dis. 170: 381–406.

    Google Scholar 

  • Fernandez, E. (1986). A classification system of cognitive coping strategies for pain.Pain 26: 141–153.

    Google Scholar 

  • Flor, H., Haag, G., Turk, D. C., and Koehler, H. (1983). Efficacy of EMG biofeedback, pseudo-therapy, and conventional medical treatment for chronic rheumatic back pain.Pain 17: 21–31.

    Google Scholar 

  • Flor, H., Haag, G., and Turk, D. C. (1986). Long-term efficacy of EMG biofeedback for chronic back pain.Pain 21: 195–202.

    Google Scholar 

  • Follick, M. J., Zitter, R. E., and Ahern, D. K. (1983). Failures in the operant treatment of pain. In Foa, E. B., and Emmelkamp, P. (eds.),Failures in Behavior Therapy, Wiley, New York.

    Google Scholar 

  • Follick, M. J., Ahern, D. K., and Laser-Wolston, N. (1984). Evaluation of a daily activity diary for chronic pain patients.Pain 19: 373–382.

    Google Scholar 

  • Holroyd, K. A., Penzien, D. B., Hursey, K. G., Tobin, D. L., Rogers, L., Holm, J. E., Marcille, P. J., Hall, J. R., and Chila, A. G. (1984). Change mechanisms in EMG biofeedback training. Cognitive changes underlying improvements in tension headaches.J. Consult. Clin. Psychol. 52: 1039–1059.

    Google Scholar 

  • Kazis, L. E., Meenan, R. F., and Anderson, J. J. (1983). Pain in the rheumatic diseases. Investigation of a key health status component.Arth. Rheum. 26: 1017–1021.

    Google Scholar 

  • Kerns, R. D., Turk, D. C., and Rudy, T. E. (1985). The Westhaven-Yale Multidimensional Pain Inventory (WHYMPI).Pain 23: 345–356.

    Google Scholar 

  • Lefebvre, M. F. (1981). Cognitive distortion and cognitive errors in depressed psychiatric and low back pain patients.J. Consult. Clin. Psychol. 49: 517–525.

    Google Scholar 

  • McArthur, D. L., Cohen, M. J., Gottlieb, H. J., Naliboff, B. D., and Schandler, S. L. (1987). Treating chronic low back pain. I. Admissions to initial follow-up.Pain 29: 1–22.

    Google Scholar 

  • Meenan, R. F., Gertman, P. M., and Mason, J. H. (1980). Measuring health status in arthritis: The Arthritis Impact Measurement Scales.Arth. Rheum. 23: 146–152.

    Google Scholar 

  • Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods.Pain 1: 277–299.

    Google Scholar 

  • Rosenstiel, A. K., and Keefe, F. J. (1983). The use of coping strategies in chronic low back pain patients: Relationships to patient characteristics and current adjustment.Pain 17: 33–44.

    Google Scholar 

  • Schmidt, A. J. M. (1985). Cognitive factors in the performance level of chronic low back pain patients.J. Psychosom. Res. 29: 183–189.

    Google Scholar 

  • Skevington, S. M. (1983). Chronic pain and depression: Universal or personal helplessness.Pain 15: 309–317.

    Google Scholar 

  • Smith, T. W., Follick, M. J., Ahern, D. K., and Adams, A. (1986). Cognitive distortion and disability in chronic low back pain.Cognit. Ther. Res. 10: 201–210.

    Google Scholar 

  • Spanos, N. P., Radtke-Bodorik, H. L., Ferguson, J. D., and Jones, B. (1979). The effect of hypnotic susceptibility, suggestions for analgesia, and the utilization of cognitive strategies on the reduction of pain.J. Abnorm. Psychol. 88: 282–292.

    Google Scholar 

  • Timko, C., and Janoff-Bulman, R. (1985). Attributions, vulnerability, and psychological adjustment: The case of breast cancer.Health Psychol. 4: 521–544.

    Google Scholar 

  • Turk, D. C., and Rudy, T. E. (1986). Coping with chronic illness: The mediating role of cognitive appraisal. In McHugh, S., and Vallis, T. M. (eds.),Illness Behavior: A Multidisciplinary Model, Plenum, New York, pp. 309–320.

    Google Scholar 

  • Turk, D. C., Meichenbaum, D. H., and Genest, M. (1983).Pain and Behavioral Medicine: A Cognitive-Behavioral Perspective, Guilford, New York.

    Google Scholar 

  • Turner, J. A., and Chapman, C. R. (1982). Psychological interventions for chronic pain: A critical appraisal. II. Operant conditioning, hypnosis, and cognitive-behavior therapy.Pain 12: 23–46.

    Google Scholar 

  • Turner, J. A., and Clancy, S. (1986). Strategies for coping with chronic low back pain: Relationship to pain and disability.Pain 24: 355–364.

    Google Scholar 

  • Wallston, K. A., Wallston, B. S., and DeVellis, R. (1978). Development of the multidimensional health locus of control (MHLC) scales.Health Educ. Monogr. 6: 161–170.

    Google Scholar 

  • Wilkinson, L. (1980).SYSTAT: The System for Statistics, SYSTAT, Evanston, Ill.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Support for this research was provided to the first author by DFG (German Research Foundation) Grants Fl 156/1-1 and Fl 156/2-1 and to the second author by NIH Grant RO1 AR NS 38698-01.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Flor, H., Turk, D.C. Chronic back pain and rheumatoid arthritis: Predicting pain and disability from cognitive variables. J Behav Med 11, 251–265 (1988). https://doi.org/10.1007/BF00844431

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00844431

Key words

Navigation